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​Alaska WIC Logo

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Contact Info:​

State of Alaska
WIC Program Office
Phone: 907-465-3100
Fax: 907-465-3416
Email: wic@alaska.gov

PO Box 110612
Juneau, AK 99801





Forms for WIC Participants



Application Forms

Please be sure to check your eligibility before applying for WIC benefits.

Instructions

  1. Open, print and complete the necessary forms listed below.
  2. Call the WIC clinic nearest to you and let them know that you have completed the application forms. (Visit our eligibility page for more information on how to apply.)
  3. Attend your appointment, and make sure you bring everything you need.

1. Download, Print and Complete Forms

Adobe Acrobat ReaderThe forms listed below are PDF files. You should be able to click on them and save or print them. You may need to download and install the free Adobe Acrobat Reader.


2. Call the WIC Clinic Nearest To You

Call the clinic to let them know you want to apply and that you have completed the application forms. The WIC staff will let you know what to do with the application. If you live in a town that has a WIC office, you will be given an appointment or information about walk-in hours. If you live in a town that does not have a WIC clinic, your application will be processed by mail. 

3. Things to Bring to Your First Appointment

Please bring the following to your WIC appointment:
  • Completed application forms.
  • Proof of income for yourself and child. Samples of proof of income are Medicaid/Denali Kid Care card, pay stub, letter from employer.
  • Proof of identification. Samples of identification are driver's license, passport, birth certificate, social security card, immunization record.
  • Each infant/child you are applying for as we will take their height and weight.
    • Proof of Pregnancy if you are pregnant.
    • Immunization cards for each child.
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Additional Forms for Participants


Alaska WIC Vendor Program Complaint Form
If you need to register a complaint about the service you received or the supply of WIC products at a WIC store, please complete this form and mail it to the WIC Vendor Coordinator at the address on the bottom of this web page. 

Enteral Nutrition Prescription Request Form
Requires the original signature of medical provider licensed to write prescriptions in Alaska and provides the Alaska WIC program with the medical documentation needed to issue WIC warrants to purchase WIC approved non-contract formula.

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